Ankor Children’s Hospital

Previously, I had organised with Oly Shipp (Management Advisor in Thmar Puok) to do some paediatric teaching in the North West regions. Apart from sharing knowledge to other hospitals, it was a good opportunity to visit Angkor Children’s Hospital and Siem Reap en route.

Siem Reap: Just off Pub Street

Angkor Children’s hospital has steadily grown in size since its opening in 1999. It was the vision of the famous Japanese photographer Kenro Izu.  He had arrived in Cambodia to photograph the Angkor temples, however was struck by the deficiencies in medical care for children. Angkor Children’s Hospital provides free medical and surgical treatment to any child that is able to make the journey. In addition to this, they also run outreach programmes to local communities around Siem Reap province as well as run training sessions for Cambodian doctors.

After attending a ward round, it seems that the spectrum of illnesses I encounter in Stung Treng is not that dissimilar to what I observed in Siem Reap. With the advantages of biochemical, microbiological and radiological investigations, the doctors are able to reach some conclusive diagnoses. Whereas in Stung Treng, I have learned to be comfortable with very little certainty. It was certainly reassuring to see that my presumptive diagnoses and treatments have been fairly appropriate.

A limiting factor in Stung Treng is the absence of any breathing support. In the final stages of respiratory illnesses, the effort of breathing becomes too great a challenge for the patient to bare, resulting in an apnoea (stopping breathing). In the absence of any breathing support, these children will almost all die.

One type of respiratory support is providing CPAP (Continuous Positive Airway Pressure) i.e. using a machine to force air into the lungs and so reducing the effort of breathing on the child. ACH have a low tech solution involving the use of nasal prongs, oxygen and water. Unfortunately, they get the components from a company in the United States!

CPAP at Angkor Childrens Hospital

However, having grown up watching Blue Peter, I have managed to finally make use of that double-sided cellotape and have created a CPAP set-up of some design. Hopefully, it will prevent the children from deteriorating beyond the point of recovery.

CPAP Stung Treng Style

When visiting ACH, I had the opportunity to observe the admission of a new patient – a premature baby. I was highly impressed with the coordinated team efforts of two doctors and five nurses as they set up the monitoring equipment, IV drips and prescribed the medications. Everything was done with calm efficiency. It is worlds apart from the apathetic inefficiency I’ve observed elsewhere.

Ankor Children’s Hospital has integrated also into Cambodian medical system by offering paediatric training programmes for newly qualified doctors. Furthermore, ACH has close links with the government’s Provincial Referral Hospital.

Cooking Facilities for Patients

The staff receive significantly higher salaries than their government counterparts.  I am sure that this places no small part in achieving a motivated and hard working workforce.  The staff all work full time in a shift system, which includes the afternoon! There is also a culture of ongoing professional development, with daily lectures and bedside teaching.

The Childrens Play Area

There is a government project underway to provide a higher salary for healthcare staff, with the condition that they do not practice privately. However, the proposed new salary is still significantly lower than what they would normally earn overall. So, you can imagine not many people are willing to accept this condition! Interestingly though, while the ACH salary is considerably higher than the average government wage, the absence of a private practice means that some doctors will be accepting a pay cut in return for the training benefits.

Court Yard

While the hospital excels in its quality of service and semi-integration into the official health service, its weakness lies in its financial dependence on foreign aid. Therefore, it once again highlights the cycle of dependency that exists in Cambodia.

The fragility of vast numbers of NGOs has been demonstrated as organisations struggle to weather the current economic climate. NGOs fiercely compete for limited pools of money, spending huge amounts of resources simply trying to exist. Local people strive to work with international organisations rather than government for the benefits of higher salaries and the opportunity to work with foreigners.

Having said this, it is hard to argue about ‘sustainability’ when your objective is clear– children deserve to receive decent medical care. ACH is staffed by dedicated Cambodian staff who genuinely work hard for the betterment of their nation. While it is not yet self-sustainable, at least it is achieving what it was intended and more.